I. Characteristics of elderly patients with hypertension.
Geriatric hypertension is defined as primary hypertensive disease patients aged 65 years and above with sustained blood pressure or more than 3 times non-same day quiet state sitting blood pressure, systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Despite the good efficacy of western medicine in lowering blood pressure, however, due to the own characteristics of the elderly, even if they take once-daily long-acting antihypertensive drugs on time, patients’ blood pressure still shows: high volatility of blood pressure level; the difference between systolic and diastolic blood pressure (high and low pressure), i.e., excessive pulse pressure; sometimes postural hypotension; and postprandial hypotension. These conditions are difficult to control with western medicine alone even with long-acting antihypertensive drugs that have a good antihypertensive effect, and through herbal treatment, balancing yin and yang and unblocking the veins, the blood pressure regulation function of the body can be improved, blood circulation can be improved, blood pressure stability can be promoted, pulse pressure can be reduced, and postural hypotension and postprandial hypotension can be eliminated.
Second, Western medicine treatment.
1, the clinical characteristics of geriatric hypertension are as follows: First: the increase in systolic blood pressure is dominated by an increase in pulse pressure: 60% of geriatric hypertension. Older people systolic blood pressure increases with age, while diastolic blood pressure slowly decreases after the age of 60, thus showing an increase in pulse pressure clinical often see elderly patients’ blood pressure: 180/60mmHg, because there is no one only to lower the systolic blood pressure (commonly known as high pressure) without lowering the diastolic blood pressure (low pressure) of Western antihypertensive drugs, so like this blood pressure simple Western medicine is difficult to choose to appropriate, treatment is very difficult. Pulse pressure is an indicator of the elasticity of the arteries, the increase in pulse pressure in the elderly is an important predictor of cardiovascular events, the greater the pulse pressure the greater the chance of cardiovascular events, and the total mortality rate increases accordingly. Second: blood pressure fluctuations, prone to postural hypotension: With age, the arterial wall stiffness increases and compliance decreases in elderly patients, and the sensitivity of carotid pressure receptors decreases, i.e., their ability to stabilize blood pressure decreases, and it is difficult to avoid such blood pressure fluctuations even with the application of once-daily long-acting antihypertensive drugs. As a result, blood pressure tends to fluctuate significantly with mood and seasonal changes, and there are more cases of “morning peak” blood pressure and postprandial hypotension. Postural hypotension is likely to occur with changes in body position, especially with diabetes, hypovolemia and the application of diuretics, vasodilators or psychotropic drugs. Third: common blood pressure circadian rhythm abnormalities: elderly hypertensive patients with non-arrythmic blood pressure (nighttime blood pressure compared to daytime blood pressure drop of less than 10%) incidence can be as high as 60% or more. Fourth: often accompanied by a variety of diseases: elderly hypertension is often accompanied by arterial atherosclerosis, hyperlipidemia, diabetes, renal failure, dementia and other diseases, the incidence of coronary heart disease, stroke and other cardiovascular and cerebrovascular accidents and recurrence rate increased significantly.
2, elderly patients with hypertension using Western antihypertensive drugs.
First, for elderly patients who are just found to have hypertension, the start of antihypertensive drugs should start with a small dose, and close observation should not make the blood pressure drop too low too fast: on the one hand, the elderly drug metabolism is relatively slow, this is because the kidney blood flow decreases with the increase in age. The decrease in renal blood flow makes the kidney’s ability to clear the drug decrease. Giving the same dose of drug to the elderly and young people, the elderly will have a lower clearance of the drug by the kidney and a higher concentration of the drug in the blood, resulting in lowering the blood pressure too low and too fast. On the other hand, the stiffness of the arterial wall increases in elderly patients, and the sensitivity to changes in blood pressure is subsequently reduced, making it very easy for postural hypotension to occur. For example, diuretics, due to the decreased ability of the elderly to retain sodium themselves, the amount of fluid in the body is relatively reduced, and after taking diuretics, the effective blood volume will be significantly reduced, which can lead to a decrease in blood supply to various organs in the body, making it easy to develop postural hypotension, resulting in insufficient blood supply to the brain leading to dizziness or even syncope. In addition, small doses help to observe drug reactions. For example, alpha-blockers may cause postural hypotension in elderly patients with hypertension, so treatment should be started with a small dose at bedtime and monitored to avoid postural hypotension. In the treatment effect need to reduce the drug, should also start from a small dose gradually reduce the drug, if suddenly reduce the drug or even stop the drug is likely to cause blood pressure rebound, headache, dizziness and sympathetic excitement and other withdrawal syndrome, and even lead to hypertensive encephalopathy, the occurrence of strokes.
Second, you should choose to take once a day long-acting antihypertensive drugs: elderly hypertension is common circadian rhythm abnormalities and high blood pressure in the morning the so-called “morning peak” phenomenon. Therefore, as far as possible, the use of a once-a-day dose of long-acting drugs that have a continuous 24-hour antihypertensive effect can effectively control nighttime blood pressure and morning peak blood pressure, and more effectively prevent the occurrence of cardiovascular and cerebrovascular complications. If you use short- or medium-acting preparations, you need to take the medication 2-3 times a day. Due to the memory loss of the elderly, even some mentally challenged patients tend to miss the dose, thus affecting the efficacy. Therefore, in order to ensure that no dose is missed, family members should check the dosing status of the elderly daily.
Third, the combination of two or more drugs: Combination therapy can take advantage of the different mechanisms of different kinds of antihypertensive drugs, which can have a synergistic effect. Therefore, small-dose combination therapy is more effective than high-dose monotherapy in lowering blood pressure, with fewer adverse reactions and better target organ protection. When the conventional dose of a single drug cannot lower blood pressure to the target, multiple drug combination therapy should be used. Elderly patients with hypertension often need to take more than two kinds of antihypertensive drugs to achieve the blood pressure standard because the overall blood pressure level is higher than that of young and middle-aged patients.
Fourth, the use of differentiated individualized treatment plan: elderly hypertension is often accompanied by a variety of diseases, so we should choose different mechanisms of action of antihypertensive drugs according to the characteristics of elderly individuals. Generally speaking, if systolic blood pressure is the main cause of hypertension in the elderly, diuretics and calcium antagonists are more effective in lowering systolic blood pressure, such as amlodipine and hydrochlorothiazide; b-blockers such as betaloc or long-acting calcium antagonist amlodipine or angiotensin-converting enzyme inhibitor enalapril are preferred for combined coronary heart disease and stable angina; angiotensin-converting enzyme inhibitor enalapril, angiotensin II receptor antagonist are preferred for combined diabetes. In combined chronic kidney disease, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are beneficial in preventing the progression of kidney disease, and in severe cases, a combination of collateral diuretics may be required; for stroke prevention, angiotensin II receptor antagonists are preferred to b-blockers and calcium antagonists to diuretics; for improving left ventricular hypertrophy, angiotensin II receptor antagonists are preferred to b-blockers; for slowing carotid artery For some elderly male patients with prostatic hypertrophy or patients whose blood pressure cannot be controlled satisfactorily by other antihypertensive drugs, α-blockers can also be used for antihypertensive treatment. At the same time, it should be combined with drugs for the treatment of combined diseases.
In conclusion, the application of Western medicine to lower blood pressure in the elderly should follow the principles of starting with small doses, giving preference to long-acting agents, combined application and individualization according to different physical conditions.
However, from the clinical point of view, especially in the elderly over 70 years old, the clinical characteristics of hypertension in the elderly are especially prominent, such as large pulse pressure, large blood pressure fluctuation, postural hypotension, postprandial hypotension, and abnormal blood pressure rhythm. The clinical application of Western medicine alone, even if the half-life of 24 hours of very good long-acting antihypertensive drugs can not make the elderly people’s blood pressure to achieve a satisfactory degree of stability, manifested as high and low blood pressure, dizziness and walking inconvenience. The patient’s family feels very distressed, frequently changing antihypertensive drugs, using all the antihypertensive drugs, and the treatment lasts for a long time but cannot eliminate some uncomfortable symptoms such as dizziness, weakness and difficulty in moving due to unstable blood pressure. In contrast, the combination of Chinese herbal medicine treatment can overcome the shortcomings of purely western medicine treatment and make the blood pressure of the elderly stabilize and eliminate the uncomfortable and painful symptoms.
Third, herbal treatment.
According to the theory of Chinese medicine, the physical condition of the elderly belongs to the deficiency of positive energy, the imbalance of yin and yang, the internal obstruction of phlegm and stagnation, and the irregularity of the veins and collaterals. Therefore, the combination of these treatments can enhance the physical fitness of the elderly, strengthen the spleen and kidney, tonify the kidney and benefit the essence, pacify the liver and submerge the yang, calm the mind and tranquilize the spirit, and promote blood pressure stability. For the elderly with unstable blood pressure, postural hypotension, and postprandial hypotension, which are difficult to be solved by western medicine, treatment with Chinese herbal medicine can achieve very good results. In addition, it can improve the ischemia of heart, brain, kidney and other important organs while treating hypertension, so that the patient’s dizziness, weakness of limbs and insufficient blood supply to the organs caused by the drop of blood pressure can be improved, and avoid the symptoms of dizziness, heart panic and chest tightness, weakness of limbs and so on after the patient uses western medicine to lower blood pressure.
Our clinical treatment method has been summarized for a long time, which is to add and reduce the amount of Shu Vine Drink.
We use Tian Ma, Hooked Vine, Chuan Dao, Pueraria Mirifica, Huai Niu Knee, Danshen, Dulcimer, Fructus Astragali, Fructus Lycii, and Di Long. This formula has the therapeutic effect of tonifying the kidneys, invigorating blood and promoting circulation.
1, insomnia: can add nightshade vine, poria, Zhi Mu and jujube.
2, Those with hot flashes: Zhi Mu, Huang Bai, Gardenia, Dan Pi, etc. can be added.
3. For those who have coldness in the lower limbs and hot flashes at the same time: Zhi Mu, Huang Bai, Radix Angelicae Sinensis, Epimedium, Bacopa monniera, etc. can be added.
4. Patients who simply have cold extremities and fear of cold: you can add Radix et Rhizoma Polygonati, Cinnamon, Radix Rehmanniae, Radix Rehmanniae. And there are abdominal cold, diarrhea in Yang spleen deficiency patients can add dry ginger, white atractylodes Radix Codonopsis and other treatments.
5, short of breath is not enough to absorb, moving dizziness patients: heavy use of Huang Qi can be used 50 grams, add red Jing Tian, acanthopanax, etc., at the same time can add Citrus Aurantium or Chen Pi to broaden the middle and lower qi.
6, fat people with phlegm, thick and greasy tongue patients can add bile star, Semen, Poria, Chen Pi, etc.
7, constipated patients with fire can choose cassia seeds as well as acacia flowers; or Yang deficiency fear of cold people choose cistanches; Yin deficiency tongue red people choose He Shou Wu, angelica, etc.; and Qi deficiency constipation people heavy use of astragalus plus honey.
The blood pressure of elderly people over 65 years old should be maintained at a slightly higher level within the normal range. For those over seventy years old, blood pressure can be around 140/90mmHg or even slightly higher, and those over eighty years old can maintain blood pressure at around 160/100mmHg. From a clinical point of view, a little higher is not a problem, but often low blood pressure can easily lead to the occurrence of cardiac and cerebral ischemic diseases.